What Is Cystic Acne and How Is It Treated?

Why cystic acne develops

Cystic
acne is the most serious type of acne. It develops when cysts
form deep underneath your skin. This can result from a combination of bacteria,
oil, and dry skin cells that get trapped in your pores.

Although
anyone can develop acne, cystic acne tends to occur in people with oily skin.
It’s also more common in teens, women, and older adults with hormonal
imbalances.

Usually,
cystic acne can improve with age. However, the stubborn and painful bumps won’t
go away on their own. If you suspect you have cystic acne, your dermatologist
is your best line of defense. They can prescribe the medication necessary to
help clear your skin.

How to identify cystic acne

Aside
from being the most serious form of acne, cystic acne also tends to be the
largest in size. It’s also deeper within the skin. All other types appear to
rest on top of the skin’s surface.

Cystic
acne often looks like boils on the skin. Other identifying characteristics
include:

large pus-filled cyst

large white bump

redness

tender or painful to the touch

Acne
cysts are perhaps most noticeable on a person’s face. But they’re also common
on the chest, neck, back, and arms. Cystic acne may even develop on the
shoulders and behind the ears.

Picture of cystic acne

Treatment options

Due
to the severity of cystic acne, over-the-counter (OTC) treatments for acne aren’t
strong enough. This means you’ll need to see a dermatologist for prescription
medications. Depending on the type of treatment used, you may not see full
results for up to eight weeks.

Talk
to your doctor about the following methods used to treat cystic acne. Some
cases require combination therapies.

Isotretinoin

Isotretinoin (Accutane), a powerful
prescription medication, is considered the most effective treatment measure for
cystic acne. It’s derived from a powerful form of vitamin A, taken in tablet
form every day.

About 85
percent
of people who take it experience improvements within four to six months. Despite
the efficacy, there are some serious risks associated with isotretinoin.

Oral antibiotics

Oral
antibiotics may be used to treat cystic acne if it covers a large area of your
skin. These work by decreasing bacteria and inflammation that could be
contributing to cystic acne formation. However, antibiotics don’t alleviate
excess oil and dead skin cells.

Antibiotics should only be used in the short term, due
to concerns over bacterial resistance. If antibiotics aren’t effective, then your
doctor will likely recommend you start taking isotretinoin.

Possible
side effects of oral antibiotics may include:

abdominal pain

diarrhea

nausea

sun sensitivity

vomiting

Topical retinoids

Topical
retinoids are also derived from vitamin A. However, these don’t have quite the
strength of isotretinoin. These work by unplugging hair follicles to remove and
prevent severe acne.

Retinoids
are sometimes used in conjunction with topical antibiotics to make them more
effective. Topical retinoids can be used on a daily basis and come in the form
of creams, gels, and lotions.

While
one OTC retinoid (adapalene) is currently available, cystic acne is usually
only responsive to prescription-strength formulas.

These
include:

Avage

Avita

Differin

Retin-A

Tazorac

Using
topical retinoids can make your skin red and can also cause it to peel. These
side effects are usually temporary as your skin gets used to the medication.
Retinoids can also make you more susceptible to sunburn, so be sure to wear
sunscreen.

Spironolactone

Spironolactone (Aldactone) is another possible prescription treatment
measure for cystic acne. Traditionally, it’s used as a diuretic to help treat
edema and high blood pressure. In terms of acne, this medication can work by
managing excess androgen levels that could be contributing to inflammatory
acne. It’s typically only effective in women with acne on their jawline or lower
face.

Spironolactone may cause
birth defects, so you shouldn’t take it if you’re planning a pregnancy. People
with kidney disease also shouldn’t use this medication.

Researchers
in one 2012 study found that doses of 50
to 100 milligrams (mg) per day work best. However, it isn’t uncommon to go as
high as 200 mg daily.

Oral contraceptives

Oral contraceptives are a viable option for
cystic acne in some women. This method is especially effective if you tend to
develop acne cysts during hormone fluctuations related to your menstrual cycle.

Birth
control pills contain estrogen, which can help regulate overall hormone levels
and possibly reduce acne.

Still,
oral contraceptives aren’t for everyone. These medications may not be
appropriate for you if you smoke, have blood clots, or are trying to get
pregnant.

Will scarring develop?

Out
of all types of acne, cystic acne is the most likely to scar. You can reduce
the risk of scarring by leaving all cysts alone. This means you can’t ever pick
or pop cysts. Picking at this type of acne can also spread infections.

Though
it’s best to prevent acne scars in the first place, there are some treatments
you can try to reduce the appearance of acne scars. However, it’s important to
treat active acne first and address scars after the acne is under control.

These
include:

chemical peels

dermabrasion from a dermatologist

laser resurfacing from a dermatologist

General skin care tips

Taking
care of your skin is the best way you can help prevent cystic acne.

Aim
to:

Wash your face once a day in the evening. Use a cleanser that removes
excess dirt and oil, but isn’t excessively harsh or drying. Scrubs can irritate
existing inflammatory acne and make it worse.

Avoid picking at your skin. Even picking less severe forms of acne can
lead to cystic buildups.

Select makeup products that are labeled "noncomedogenic" and "oil-free."
These are less likely to clog your pores.

Never go to bed with makeup on.

Wear sunscreen every day. This will
help prevent sunburn from acne medications that may sensitize you to sun
exposure, as well as skin cancer.

Some
of the following lifestyle changes can also impact your overall skin health and
reduce cystic acne from forming:

Avoid foods that have high glycemic levels. These include white
breads, pastas, and rice, as well as sugary treats.

Wash your face and body after working out to remove oil and bacteria.

See your dermatologist

In
most cases of cystic acne, you’ll need to see a dermatologist to clear it up.
Whether it’s a prescription medication or surgical removal, your dermatologist
is your best resource. Acne cysts are so difficult to treat at home. Cystic
acne can also lead to significant scarring.

In
addition to medical treatments, your dermatologist can also help you prevent recurring cases of acne. Keep in mind
that any new skin care regimens can take several months
before you see significant results. Leaving the cysts alone can also help
prevent them from coming back.

This feature is for informational purposes only and should not be used to replace the care and information received from your health care provider. Please consult a health care professional with any health concerns you may have.